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Abstract

Introduction

Proteasome inhibitors have emerged as quintessential therapies for light-chain (AL) amyloidosis and multiple myeloma in the last decade. While these agents are highly effective, reports have also documented toxicities affecting various organ systems. Whereas gastrointestinal (GI) toxicities are a relatively common occurrence with proteasome inhibitors, severe GI complications are exceedingly rare.

Case Report

We describe a unique case of a patient with AL amyloidosis who developed cecal volvulus after four weeks of treatment with carfilzomib. This severe GI manifestation has not been previously described in the literature.

Management and Outcome

The patient required right hemicolectomy. After clinical recovery, she restarted reduced-dose carfilzomib. She did not have any severe GI side effects following dose reduction, and continues with the current treatment regimen to the present day.

Discussion/Conclusion

The causality between volvulus and the treatment with carfilzomib was probable, with a documented score of 6 on the Naranjo probability nomogram. The exact mechanism behind this effect of carfilzomib has yet to be elucidated.

Keywords

Carfilzomib volvulus toxicity amyloidosis autonomic nervous system

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References

Naranjo

Busto

Sellers

, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.

Ryšavá

. AL Amyloidosis: advances in diagnostics and treatment. Nephrol Dial Transplant 2019; 34: 1460–1466.

Venner

Lane

Foard

, et al. Cyclophosphamide, bortezomib, and dexamethasone therapy in AL amyloidosis is associated with high clonal response rates and prolonged progression-free survival. Blood 2012; 119: 4387–4390.

Fukushima

Nakamura

Iwao

, et al. Efficacy and safety of bortezomib plus dexamethasone therapy for refractory or relapsed multiple myeloma: once-weekly administration of bortezomib may reduce the incidence of gastrointestinal adverse events. Anticancer Res 2011; 31: 2297–2302.

Kyriakou

Worthington

Sharpley

, et al. Carfilzomib is an effective upfront treatment in AL amyloidosis patients with peripheral and autonomic neuropathy. Br J Haematol 2019; 187: 638–641.

Groen

van de Donk

Stege , et al. Carfilzomib for relapsed and refractory multiple myeloma. Cancer Manag Res. 2019 ;11:2663–2675.

De Sousa-Amorim

Revuelta

Diekmann

, et al. High incidence of paralytic ileus after bortezomib treatment of antibody-mediated rejection in kidney transplant recipients. Transplantation 2015; 99: 170–171.

Keating

Dasanu

. Strategy to reduce bortezomib-induced paralytic ileus in patients with myeloma and impaired renal function. BMJ Case Rep. 2016; 2016: bcr2016217000. doi: 10.1136/bcr-2016-217000.

Tjionas

Gupta

. Heart failure secondary to carfilzomib-induced heart block in multiple myeloma patients. J Oncol Pharm Pract 2017; 2: 152–156.

10.

Consorti

Liu

. Diagnosis and treatment of caecal volvulus. Postgrad Med J 2005; 81: 772–776.

11.

Kumar

Appavu

Abcarian

, et al. Amyloidosis of the colon. Diseases of the Colon & Rectum 1983; 26: 541–544.

12.

Koda

Mori

Shimizu

, et al. Early onset of paralytic ileus caused by simultaneous administration of bortezomib and azole antifungals in multiple myeloma patients. Rinsho Ketsueki 2012; 53: 760–764.

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